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Big News from CMS..

The federal government today granted California permission to make significant cuts to Medi-Cal provider rates, raising new concerns about access to care for California patients. Other proposed Medicaid rate cuts were rejected, however, and a new, public monitoring system was required to continually assess whether Medi-Cal patients have adequate access to the care they need.

IMPACT ON ACCESS: Even before these cuts, California has one of the worst Medicaid provider reimbursement rates in the nation. These additional cuts will clearly impact access to care for millions of Californians. While we are concerned about the impacts of the cuts that were allowed to go forward, it’s important that other provider cuts were rejected as going too far in restricting access. The new monitoring system now required by the federal government is essential in publicly documenting the real access to care that Medi-Cal patients have.

MANY CUTS ALLOWED: The cuts approved, proposed under both the Schwarzenegger and Brown Administrations, include a 10% provider cut on many outpatient services, including physicians, clinics, optometrists, therapists, laboratories, dental, durable medical equipment, and pharmacy, and a 10% provider cut on freestanding nursing and subacute facilities, and distinct part/nursing facility-B services.

SOME CUTS REJECTED: The cuts rejected include a 10% cut to physician and clinic services for children, home health services or distinct part subacute facilities. Other cuts to other long-term care facilities are still under review.

NEW MONITORING IS CRUCIAL: Moving forward, the state now has a monitoring system required in its state plan, based on 23 metrics, to measure access to care by Medi-Cal patients. They include: How many Medicaid recipients have a usual source or care? How many providers are participating in Medicaid? How many Medicaid patients have seen a doctor at least once? Is there an increase in ER visits by Medicaid patients?

It will be crucial for both California and the federal government to closely monitor if Medicaid patients truly have access to care. A Medicaid card can’t be simply a license to hunt for a provider when there’s no one to take them.

REVENUES NEEDED TO RESTORE CUTS: Ultimately, California needs revenues to restore and prevent these cuts, and shore up the health care system on which we all rely. We are all impacted if our doctors, hospitals, and health providers are cut to the bone.

DOCTOR VISIT LIMITS & CO-PAYS PENDING: We continue to await the federal government’s decision on two additional cuts proposed by California to impose a limit of doctor visits and onerous cost-sharing on low-income families, violating the minimum standards of Medicaid law. For both the sake of our families and our health system, the federal government needs to prevent California or other states from undermining the minimum standards for providing coverage.